Occupational lung diseases represent an important and serious public health problem. In order to contribute to the knowledge of the risks associated with the exposure to fertilizer production an environmental and epidemiological cross-sectional study was performed among workers of this industry in Rio Grande, RS, Brazil. The ATS-DLD-78 questionnaire was applied, a thoracic radiological study was carried out, and the pulmonary function testing was evaluated through spirometry in 413 employees, 305 being the exposed group and 108 the non-exposed group. The exposed workers were all men, 74.1% had attended elementary school (at least some years), mean age was 38 (± 7.6) and mean time of exposure was 11.8 years (± 6.7). As to cigarette smoking, 126 (41.3%) were smokers, 76 (24.9%) former smokers, and 103 (33.8%) non-smokers. The exposed group was divided into four work sections according to the specific risks of their occupational exposure. The environmental evaluation showed the presence of free silica, gaseous fluorides, and gaseous ammonia in concentrations above the tolerance limits. Results of the exposed workers were: 30.5% of them answered positively to cough, 14.7% to chronic cough, 8.5% to chronic bronchitis, 43.3% to rhinitis, and 35.4% to conjunctivitis. The multivariate analysis, after adjustment for smoking, showed statistically significant association between exposure and cough as a whole, rhinitis and conjunctivitis. The thoracic radiological studies did not point to any considerable abnormality of pneumoconiosis in the exposed workers. Most of them presented normal pulmonary function testing, not different from the controls.

Keywords: Epidemiology. Lung diseases. Respiratory tract diseases. Occupational diseases. Fertilizer industry. Evaluation. Environment.

Background: Tuberculosis is an ancient disease, which still remains one of the major ills faced by mankind in the 21st century. In recent decades, new technologies employing the knowledge gained from molecular biology studies have allowed for more accurate detection of tuberculosis and increased investigation of the etiology and epidemiology of the disease. Aim: Evaluating the degree of similarity among strains of Mycobacterium tuberculosis provided by the Phthisiology Sector of Centro de Saúde Navegantes (Navegantes Health Clinic) in Porto Alegre, RS, Brazil. Method: A retrospective study was performed involving RFLP typing of 55 sputum samples from outpatients examined at the Centro de Saúde Navegantes. The results of the genotyping were correlated to the conventional epidemiology data. Results: A single pattern was seen in 39 (70.9%) of the isolates, whereas 16 isolates (29.1%) showed clustering patterns and were grouped into 8 clusters of 2 patients each. An epidemiological link was found for 6 (37.5%) of the 16 patients in the clusters. Conclusion: The appropriate combination of conventional epidemiology and genotyping of M. tuberculosis contributes to a better understanding of the dynamics of tuberculosis transmission even when such a study is performed in a single, isolated health clinic.

Keywords: Mycobacterium tuberculosis. Transmission. Polymorphism, Restriction Fragment Length. Epidemiology.

Objective: To determine the prevalence and the characteristics of Mycoplasma pneumoniae-related community-acquired pneumonia (CAP) and parapneumonic pleural effusion (PPE) in children and adolescents. Methods: This was a retrospective observational study involving 121 patients with CAP/PPE hospitalized in a tertiary referral hospital between 2000 and 2008, divided into six groups according to the etiologic agent (G1 to G6, respectively): M. pneumoniae with or without co-infection, in 44 patients (group 1); etiologic agents other than M. pneumoniae, in 77 (group 2); M. pneumoniae without co-infection, in 34 (group 3); Streptococcus pneumoniae, in 36 (group 4); Staphylococcus aureus, in 31 (group 5); and M. pneumoniae/S. pneumoniae co-infection, in 9 (group 6). Results: In comparison with group 2, group 1 showed higher frequencies of females, dry cough, and previous use of beta-lactam antibiotics; longer duration of symptoms prior to admission; and lower frequencies of use of mechanical ventilation and chest tube drainage. In comparison with groups 4 and 5, group 3 showed higher frequencies of previous use of beta-lactam antibiotics and dry cough; longer duration of symptoms prior to admission; a lower frequency of use of chest tube drainage; a higher mean age and a lower frequency of nausea/vomiting (versus group 4 only); and a lower frequency of use of mechanical ventilation (versus group 5 only). M. pneumoniae/S. pneumoniae co-infection increased the duration of symptoms prior to admission. Conclusions: In this sample, the prevalence of M. pneumoniae-related CAP/PPE was 12.75%. Although the disease was milder than that caused by other microorganisms, its course was longer. Our data suggest that M. pneumoniae-related CAP/PPE in children and adolescents should be more thoroughly investigated in Brazil.

Keywords: Pleural effusion; Empyema, pleural; Pneumonia; Mycoplasma pneumoniae.

Objetivo: Realizar a tradução para a língua portuguesa e a adaptação cultural para uso no Brasil do Quality of Communication Questionnaire (QOC) para pacientes com DPOC em cuidados paliativos. Métodos: Após a aprovação do autor do questionário e do comitê de ética da instituição, a versão original do QOC com 13 itens foi traduzida, de forma independente, por dois tradutores brasileiros com fluência na língua inglesa. Uma síntese das duas traduções foi realizada por uma médica bilíngue e os dois tradutores, que chegaram a um consenso, gerando uma versão na língua portuguesa. Essa versão foi retraduzida por dois tradutores nativos de países de língua inglesa com fluência na língua portuguesa. Para resolver quaisquer discrepâncias, um comitê de especialistas comparou a versão original com todas as versões produzidas e, assim, obteve-se a versão pré-final do QOC. O pré-teste foi aplicado em 32 pacientes internados em UTIs de três hospitais públicos da grande Florianópolis (SC) para avaliar a clareza e a aceitabilidade cultural da versão pré-final do QOC. Resultados: A média de idade dos pacientes foi de 48,5 ± 18,8 anos. A maioria dos itens foi bem compreendida e aceita, recebendo pontuações ≥ 8. Um item, sobre morte, suscitou dificuldades na compreensão dos participantes do pré-teste. Ao submeter a retradução ao autor do QOC, ele solicitou alterações em dois itens, que foram acatadas. Após essas alterações, a versão final foi aprovada. Conclusões: A tradução e a adaptação cultural do QOC para uso no Brasil foi concluída com sucesso.

Keywords: Doença pulmonar obstrutiva crônica; Inquéritos e questionários; Comunicação; Unidades de terapia intensiva.

Objective: To study the prevalence of wheezing patterns and their associations with independent variables. Methods: Cohort study of live births in 1993 in Pelotas, Brazil. A systematic subsample (20%) of the original cohort was evaluated at 6 months, 12 months and 4 years. At 10-12 years, 87.5% of the original cohort was contacted. Wheezing was categorized: transient, wheezing at 4 years but not at 10-12; persistent, wheezing at all evaluations; late-onset, wheezing at 10-12 years. Independent variables were analyzed: gender; skin color; family income; smoking/asthma during pregnancy; breastfeeding; respiratory infection/diarrhea (during the 1st year); family members with asthma/ allergy (at 4 years and at 10-12); physician-diagnosed rhinitis/eczema (at 10-12 years). Results: The subsample comprised 897 adolescents. Wheezing patterns were expressed as prevalence (95% CI): transient, 43.9% (40.7-47.2); persistent, 6.4% (4.8-8.0); and late-onset, 3.3% (2.2-4.5). The transient pattern was more common in children from low-income families, children breastfed for less time, children with a history of respiratory infections (during the 1st year) and children with asthma in the family (at 4 years). The persistent pattern was almost twice as common in males, in children whose mothers had asthma during pregnancy, in children with respiratory infections (during the 1st year) and in children with asthma in the family (at 4 and 10-12 years). The late-onset pattern was more prevalent among those with asthma in the family (at 10-12 years) and those diagnosed with rhinitis (at 10-12 years), being less prevalent among those reporting respiratory infections (during the 1st year) and those diagnosed with eczema (at 10-12 years). Conclusions: Knowledge of the associations of wheezing patterns allows us to adopt preventive and therapeutic measures.

Keywords: Respiratory sounds; Asthma; Epidemiology; Hypersensitivity.

To evaluate the characteristics of users of inhalers and the frequency of inhaler use among adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema. Methods: A population-based study conducted in the city of Pelotas, Brazil, involving 3,670 subjects ≥ 10 years of age, evaluated with a questionnaire. Results: Approximately 10% of the sample reported at least one of the respiratory diseases studied. Among those individuals, 59% reported respiratory symptoms in the last year, and, of those, only half reported using inhalers. The use of inhalers differed significantly by socioeconomic status (39% and 61% for the lowest and the highest, respectively, p = 0.01). The frequency of inhaler use did not differ by gender or age. Among the individuals reporting emphysema and inhaler use, the use of the bronchodilator-corticosteroid combination was more common than was that of a bronchodilator alone. Only among the individuals reporting physician-diagnosed asthma and current symptoms was the proportion of inhaler users higher than 50%. Conclusions: In our sample, inhalers were underutilized, and the type of medication used by the individuals who reported emphysema does not seem to be in accordance with the consensus recommendations.

Keywords: Metered dose inhalers; Asthma; Pulmonary disease, chronic obstructive; Bronchitis; Emphysema; Dry powder inhalers.

Objective: To analyze the bidirectional association between wheezing and obesity during adolescence and the beginning of adulthood in a cohort in southern Brazil. Methods: This prospective longitudinal study used data from the 1993 birth cohort in Pelotas, Brazil. The following outcome variables were measured at 22 years of age: self-reported wheezing during the last 12 months and obesity (BMI = 30 kg/m2). The following exposure variables were measured at ages 11, 15, and 18: self-reported wheezing (no wheezing or symptom presentation in 1, 2, or 3 follow-ups) and obesity (non-obese or obese in 1, 2, or 3 follow-ups). Crude and adjusted logistical regression stratified by sex were used in the analyses. The reference category was defined as participants who presented no wheezing or obesity. Results: A total of 3,461 participants had data on wheezing and 3,383 on BMI. At 22 years of age, the prevalence of wheezing was 10.1% (95%CI: 9.1; 11.2), and obesity, 16.2% (95%CI: 15.0; 17.6). In females, the presence of wheezing in two follow-ups revealed a 2.22-fold (95%CI: 1.36; 3.61) greater chance of developing obesity at 22 years of age. Meanwhile, the presence of obesity in two follow-ups resulted in a 2.03-fold (95%IC: 1.05; 3.92) greater chance of wheezing at 22 years of age. No associations were found between wheezing and obesity in males. Conclusions: The obtained data suggest a possible positive bidirectional association between wheezing and obesity, with greater odds ratios in the wheezing to obesity direction in females and in the category of occurrence of exposure in two follow-ups.

Keywords: Asthma, BMI, Respiratory Sounds, Wheezing, Body Weight.

Objectives: To estimate the prevalence of allergic rhinitis (AR), atopic dermatitis (AD), and wheezing, and to describe their patterns of co-occurrence according to different characteristics in adolescence and early adulthood. Methods: Cross-sectional analyses from the 15-year and 22-year follow-ups of the 1993 Pelotas (Brazil) Birth Cohort. The outcomes were assessed based on self-reported data, and the patterns of co-occurrence were determined using cluster analysis. The sample was described using absolute and relative frequencies according to the independent variables. Venn diagrams were generated to visualize the co-occurrence of AR, AD, and wheezing. Results: Data on AR, AD, and wheezing were available for 4,286 participants at 15 years and 3,789 at 22 years. At 15 years, AR was reported by 20.9% of participants, AD by 25.2%, and wheezing by 33.4%. Meanwhile, at 22 years, AR was reported by 24.6%, AD by 14.2%, and wheezing by 30.7%. Notably, the overlap between AR and wheezing was greater than that of the other conditions (6.9% at 15 years and 8.3% at 22 years). Participants with lower maternal education and lower income were more likely to report having "no health condition". At 15 years, White individuals most frequently reported "three conditions" (4.1%; p<0.001), whereas at 22 years, they primarily reported "two conditions" (15.6%; p<0.001). The co-occurrence of all three health conditions was found to be greater than expected, with an observed rate 2.1 times higher (95% CI 1.4 - 3.0) at 22 years. Conclusions: This study highlights the social gradient in the diagnosis and reporting of co-occurrence of AR, AD, and wheezing

Keywords: asthma, wheezing, allergic rhinitis, atopic dermatitis, epidemiology